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Maprotiline
Maprotiline (sold as Deprilept®, Ludiomil®, Psymion®) is a tetracyclic antidepressant. It is a strong norepinephrine reuptake inhibitor with only weak effects on serotonin and dopamine reuptake. It exerts blocking effects at the following postsynaptic receptors: * Strong : alpha1 * Moderate : 5-HT2, muscarinic, H1, D2 * Weak : alpha2 * Extremely weak : 5-HT1 The pharmacologic profile of Maprotiline explains its antidepressant, sedative, anxiolytic, sympatholytic, and anticholinergic activities. Additionally, it shows a strong antagonism against Reserpine-induced effects in animal studies, as do the other 'classical' antidepressants. Although Maprotiline behaves in most regards as a 'first generation antidepressant' it is commonly referred to as 'second generation antidepressant'. Sedation has a fast onset (the same day), while remission of the depression itself is noted usually after a latent period of one to four weeks. Maprotiline does not brighten up the mood in nondepressed persons. History Maprotiline was developed and has been marketed by the Swiss manufacturer Geigy (now Novartis) since the early 1980s under the brand name Ludiomil®. Generics are widely available. Indications * Treatment of depressions of all forms and severities (endogenous, psychotic, involutional, and neurotic) * Treatment of the depressive phase in bipolar depression * For the symptomatic relief of anxiety, tension or insomnia N.B. The use of maprotiline in the treatment of enuresis in pediatric patients has so far not been systemetically explored and its use can therefore not be recommended. Contraindications Absolute * Hypersensitivity to Maprotiline or to other tri-/tetracyclic antidepressants * Hypertrophy of the prostate gland with urine hesitancy * Closed Angle Glaucoma Special caution needed * Concomitant treatment with a MAO-Inhibitor * Serious impairment of liver and kidney function * Epilepsy and other conditions that lower the seizure threshold (active brain tumors, alcohol withdrawal, other medications) * Serious cardiovascular conditions (arrhythmias, heart insufficience, state after myocardial infarction etc.) * Treatment of patients under age 18 Pregnancy and nursing If you are pregnant or thinking of becoming pregnant, before taking this medicine talk to your doctor about the benefits versus the risks to your pregnancy. Animal studies showed delayed bone development. Use this medicine only if it is clearly needed. Maprotiline should not be given to nursing mothers. If you have any questions, ask your doctor or pharmacist. Side effects The side-effect profile is comparable to other tri-/tetracyclic antidepressants. Most often seen are: * Dizziness, drowsiness, fatigue * Dry mouth, obstipation * Increased appetite and weight gain * Hypotension, tachycardia, other arrhythmias * Impaired sexual functions in men (impotence, ejaculation difficulties, decreased libido) * Allergic skin reactions (more often than with other antidepressants), photosensitivity, rarely severe skin reactions (Erythema multiforme) * Agitation, confusion * Mood swing to hypomania, worsening of psychotic disease * Seizures (more often seen with high doses) * Prolonged and painful erections (call your doctor immediately) * Leukopenia and agranulocytosis (dangerous fall in white blood cells) * Liver damage, hepatitis (rarely) * Polyneuritis (very rarely) Other uncommon side effects may be seen. Consult your doctor, if these are more than mild. Maprotiline causes a strong initial sedation (first 2 to 3 weeks of therapy) and is therefore indicated to treat agitated patients ot those with suicidal risks. It causes anticholiergic side effects with a lower incidence than Amitritypline. Originally, the manufacturer claimed that Maprotiline is better tolerated than other tri-/tetrcyclic drugs. This is not the case because seizures, leukopenia and skin reactions occur more often with Maprotiline than with comparable drugs like Amitriptyline. Necessary examinations during therapy All patients should have frequent blood pressure checks and periodic white bloodcell counts. Risk patients need also regular EKG and EEG monitoring as well. Suicidal patients Patients with suicidal thoughts, or those with previous suicidal attempts, should be monitored closely under treatment with Maprotiline. Perhaps, the decision is made to hospitalize high risk patients until remission or to prescribe an additional sedating drug like a benzodiazepine or Chlorprothixene for 2-4 weeks of initial treatment with Maprotiline (until significant remission). At least, the smallest amount of Maprotiline should be prescribed at one time to minimize the risk of deliberate overdose. Generally, many antidepressants (SSRIs, other tricyclic drugs) have been shown to cause a significant higher rate of suicidal thoughts and suicidal attempts in patients under 18 yrs. of age compared to placebo. It is not known if Maprotiline shares this risk. If Maprotiline treatment is considered essentially in these patient group, all persons so-treated should be monitored closely for signs of suicidal risk. Drug abuse and dependence Maprotiline has no known potential for abuse and psychological dependence. Withdrawal symptoms frequently seen when treatment with Maprotiline is stopped abruptly (agitation, anxiety, insomnia, sometimes activation of mania or rebound depression) are not indicative of addiction and can be avoided by reducing the daily dose of Maprotiline gradually by approximately 25% each week. If treatment has to be stopped at once due to medical reasons, the use of a benzodiazepine (e.g. Lorazepam, Clonazepam, or Alprazolam) for a maximum of 4 weeks as needed will usually suppress withdrawal symptoms. Other remarks Maprotiline may worsen psychotic conditions like schizophrenia and should be given with caution. The antipsychotic treatment should be continued. Bipolar patients during acute manic phase should not be treated. Interactions Maprotiline has a wide range of possible interactions. Some are typical for tri-/tetracyclic antidepressants, others are caused by specific metabolic effects (e.g. high plasma-protein-binding) of Maprotiline: * Irreversible MAO-Inhibitors: agitation, delirium, coma, hyperpyrexia (high fever), seizures and severe changes in blood pressure. N.B. Treatment-resistant and hospitalized patients may be treated concomitantly with an MAO-Inhibitor, if they are closely monitored and if the initial dose of the MAO-Inhibitor is low. Increased drug actions: * Other antidepressants, barbiturates, narcotics, sedating antihistaminics, anticonvulsive drugs, alcohol - resulting in increased central depression * Anticholinergics (antiparkinsonian agents, tri- and tetracyclic antidepressants) - resulting in increased anticholinergic action (dry mouth, obstipation etc.) * Sympathomimetics (also those used in local anesthetics like Noradrenaline) : sympathomimetic effects increased (increased blood pressure, pulse rate, paleness of skin etc) * Nitrates and Antihypertensives (e.g. Beta-Blockers) - increased antihypertensive action with pronounced fall in blood pressure Decreased drug actions: * Guanethidin, Reserpin, Guanfacin : antihypertensive effects decreased * Clonidin : antihypertensive effects decreased and risk of (massive) rebound hypertension. Other types of interaction: * Drugs, which induce certain enzymes in the liver, e.g. Barbiturates, Phenytoin, Carbamazepin and oral anticonceptive drugs, enhance the elimination of Maprotiline and decrease its antidepressant effects. If necessary, increase the Maprotiline dose. Additionally the blood-concentrations of Phenytoin or Carbamazepin can be increased, leading to a higher incidents of side effects of the latter drugs. Adjust the dose of these drugs, if necessary, too. * The concomitant use of Maprotiline and neuroleptics can lead to increased Maprotiline blood-levels and to seizures. Combining Maprotiline and Thioridazine could induce severe arrhythmias. * Additionally, increased blood-levels of Maprotiline are possible, if certain beta-blocking agents (e.g. Propranolol) are given concomitantly. Adjust the dose of Maprotiline if necessary. * Maprotiline may amplify the actions of coumarin-type anticogulants (e.g. Warfarin, Phenprocoumon). The plasma-prothrombin-activity must be assessed closely in order to avoid overt bleedings. Reduce the anticoagulant dose, if necessary. * Maprotiline can increase the actions of oral antidiabetic drugs (sulfonylureas) and Insulin. Diabetic patients should have regular assessments of their blood-glucose-levels. Adjust antidiabetic therapy as needed. * The concomitant application with Fluoxetin or Fluvoxamin may lead to significantly increased plasma-levels of Maprotiline with a high incidence of Maprotiline side effects. Due to the long halflives of Fluoxetin and Fluvoxamin this effect may last for a long time. Overdose If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include flushing, fast or irregular heartbeat, dry mouth, drowsiness, confusion, agitation, enlarged pupils, seizures, and loss of consciousness. Drugs commonly used to treat overdose are Physostigmine (N.B. increased risk of seizures in Physostigmine treated patients) to counteract central and peripher anticholinergic effects and Diazepam (cautiously, may deepen central depression!) against convulsion. Symptomatic measures are stabilization of blood pressure and correction of water- and electrolyt-deficits. Lidocaine can be given intravenously in cautious doses against cardial arrhythmias. The patient should be treated and monitored in an intensive care unit for several days. Due to milder anticholinergic and cardiotoxic effects of Maprotiline the acute lethal dose may be higher compared with other classical antidepressants (e.g. Amitriptyline, Doxepin). Maprotiline is definitely more toxic than the other tetracyclic drugs Mianserin and Mirtazapine. Dosage * Oral: Usually, treatment is started with 3 times 25mg or 75mg in a single dose at bedtime. The daily dose is gradually increased to 150mg daily (2 times 75mg or 3 times 50mg). Doses up to 225mg are possible, but carry the risk of a higher incidence of seizures. * Parenteral: i.m.-injections and slow iv.-infusions with total daily doses of 75 to 150mg are possible. Switch to oral forms as soon as possible. Parenteral treatment may lead to an earlier onset of action of Maprotiline but may also be associated with an increased risk of seizures. Dose Forms * Coated Pills, 10mg, 25mg, 50mg, and 75mg * Injectable concentrate, 25mg Brand Names * Ludiomil®, Deprilept® Psymion® * Generics References *Aigner, M., & Bach, M. (2000). The antinociceptive effect of antidepressants--noradrenergic versus serotonergic modes of action? : Pain Vol 88(2) Nov 2000, 217. *Albala, A. A., Weinberg, N., & Allen, S. M. (1983). Maprotiline-induced hypnopompic hallucinations: Journal of Clinical Psychiatry Vol 44(4) Apr 1983, 149-150. *Alby, J. M., & Ferreri, M. (1980). Clinical trial of maprotiline in the treatment of depressive states by general practitioners: Summary of 1,520 observations: L'Encephale Vol 6(2) 1980, 145-159. *Allain, H., Lieury, A., Brunet-Bourgin, F., Mirabaud, C., & et al. (1992). Antidepressants and cognition: Comparative effects of moclobemide, viloxazine and maprotiline: Psychopharmacology Vol 106(Suppl) Feb 1992, 56-61. *Ananth, J. (1983). New antidepressants: Comprehensive Psychiatry Vol 24(2) Mar-Apr 1983, 116-124. *Atkinson, J. H., & Slater, M. A. (2000). "The antinococeptive effect of antidepressants--noradrenergic versus serotonergic modes of action?": Reply to Aigner and Bach: Pain Vol 88(2) Nov 2000, 218. *Atkinson, J. H., Slater, M. A., Wahlgren, D. R., Williams, R. A., Zisook, S., Pruitt, S. D., et al. (1999). Effects of noradrenergic and serotonergic antidepressants on chronic low back pain intensity: Pain Vol 83(2) Nov 1999, 137-145. * Bandelow,B., Bleich, S. Kropp, S.: Handbuch Psychopharmaka (German), 2nd. edition, 2004 *Barbaccia, M. L., Ravizza, L., & Costa, E. (1986). Maprotiline: An antidepressant with an unusual pharmacological profile: Journal of Pharmacology and Experimental Therapeutics Vol 236(2) Feb 1986, 307-312. *Baturin, V. A., & Arushanyan, E. B. (1992). Effects of antidepressants on the reorganization of circadian mobility in normal and stressed rats following a change in light regime: Eksperimental'naya i Klinicheskaya Farmakologiya Vol 55(6) Nov-Dec 1992, 3-5. *Baumann, P. (1986). Pharmacogenetic aspects in antidepressant therapy: Validity of the debrisoquine test: L'Encephale Vol 12(4) Jul-Aug 1986, 143-148. *Baumgartner, A., Graf, K.-J., & Kurten, I. (1988). Prolactin in patients with major depressive disorder and in healthy subjects: II. Longitudinal study of basal prolactin and post-TRH-stimulated prolactin levels: Biological Psychiatry Vol 24(3) Jul 1988, 268-285. *Beigon, A., Essar, N., Israeli, M., Elizur, A., & et al. (1990). Serotonin 5-HT2 receptor binding on blood platelets as a state dependent marker in major affective disorder: Psychopharmacology Vol 102(1) Sep 1990, 73-75. *Benazzi, F., Mazzoli, M., & Rossi, E. (1992). Severe mania after maprotiline-induced coma: Pharmacopsychiatry Vol 25(4) Jul 1992, 207. *Benesova, O. (1982). To the pharmacological profile of maprotiline: Activitas Nervosa Superior Vol 24(2) 1982, 63-68. * Benkert, Hippius : Kompendium der Psychiatrischen Pharmakotherapie (German), 4th. edition, 2003 *Benkert, O., Szegedi, A., Wetzel, H., Staab, H. J., Meister, W., & Philipp, M. (1997). Dose escalation vs continued doses of paroxetine and maprotiline: A prospective study in depressed out-patients with inadequate treatment response: Acta Psychiatrica Scandinavica Vol 95(4) Apr 1997, 288-296. *Bogdanowicz, E., Kalinowski, A., & Swiecicki, L. (1991). Management of depression with intravenous infusions of clomipramine and maprotiline: Psychiatria Polska Vol 25(3-4) May-Aug 1991, 19-24. *Bonnaffoux, D. (1982). Multicentered study of Ludiomil 75 in the treatment of 153 ambulatory cases: Psychologie Medicale Vol 14(10) Oct 1982, 1625-1635. *Bouchard, J. M., Delaunay, J., Delisle, J. P., Grasset, N., & et al. (1987). Citalopram versus maprotiline: A controlled, clinical multicentre trial in depressed patients: Acta Psychiatrica Scandinavica Vol 76(5) Nov 1987, 583-592. *Bourin, M., Ortega, A., & Larousse, C. (1987). Viloxazine as a betamimetic antidepressant drug: Neuropsychobiology Vol 17(1-2) 1987, 35-40. *Brotman, A. W., Witkie, S. M., Gelenberg, A. J., Falk, W. E., & et al. (1988). An open trial of maprotiline for the treatment of cocaine abuse: A pilot study: Journal of Clinical Psychopharmacology Vol 8(2) Apr 1988, 125-127. *Coffinet, P. (1982). The depressions of the older patient: A report of 50 cases treated in the hospital by maprotilin: Psychologie Medicale Vol 14(3) Mar 1982, 516-527. *Cutler, M. G., Rodgers, R. J., & Jackson, J. E. (1997). Behavioural effects in mice of subchronic chlordiazepoxide, maprotiline, and fluvoxamine: I. Social interactions: Pharmacology, Biochemistry and Behavior Vol 57(1-2) May-Jun 1997, 119-125. *David, I., Filip, V., Hoschl, C., Albrecht, V., & et al. (1993). The dynamics of EEG affected by the administration of Levoprotiline and Maprotiline to patients suffering from a major depressive episode: Ceska a Slovenska Psychiatrie Vol 89(3) Jun 1993, 123-129. *de Costa, D. A., & Vilela, J. E. (1988). Treatment of depressive states with association of clomipramine and maprotiline intravenous drip infusion: Jornal Brasileiro de Psiquiatria Vol 37(1) Jan-Feb 1988, 43-46. *de Jonghe, F., Ravelli, D. P., & Tuynman-Qua, H. (1991). A randomized, double-blind study of fluoxetine and maprotiline in the treatment of major depression: Pharmacopsychiatry Vol 24(2) Mar 1991, 62-67. *de Jonghe, F., Swinkels, J., & Tuynman-Qua, H. (1991). Randomized double-blind study of fluvoxamine and maprotiline in treatment of depression: Pharmacopsychiatry Vol 24(1) Jan 1991, 21-27. *de Vanna, M., Kummer, J., Agnoli, A., Gentili, P., & et al. (1990). Moclobemide compared with second-generation antidepressants in elderly people: Acta Psychiatrica Scandinavica Vol 82(360, Suppl) 1990, 64-66. *DeCastro, R. M. (1985). Antidepressants and myoclonus: Case report: Journal of Clinical Psychiatry Vol 46(7) Jul 1985, 284-287. *Deijen, J. B., Loriaux, S. M., Orlebeke, J. F., & de Vries, J. (1989). Effects of paroxetine and maprotiline on mood, perceptual-motor skills and eye movements in healthy volunteers: Journal of Psychopharmacology Vol 3(3) 1989, 149-155. *Delini-Stula, A., Mikkelsen, H., & Angst, J. (1995). Therapeutic efficacy of antidepressnts in agitated anxious depression: A meta-analysis of moclobemide studies: Journal of Affective Disorders Vol 35(1-2) Oct 1995, 21-30. *Delini-Stula, A., & Mogilnicka, E. (1989). Rapid changes in functional responsiveness of the 5-HT system after single-dose and multiple-dose treatment with antidepressants: Effects of maprotiline and oxaprotiline and its enantiomers: Journal of Psychopharmacology Vol 3(1) 1989, 7-13. *den Boer, J. A., & Westenberg, H. G. (1988). Effect of a serotonin and noradrenaline uptake inhibitor in panic disorder: A double-blind comparative study with fluvoxamine and maprotiline: International Clinical Psychopharmacology Vol 3(1) Jan 1988, 59-74. *Dessain, E. C., Schatzberg, A. F., Woods, B. T., & Cole, J. O. (1986). Maprotiline treatment in depression: A perspective on seizures: Archives of General Psychiatry Vol 43(1) Jan 1986, 86-90. *D'Haenen, H., Morez, V. E., Kaufman, L., & Derde, M. P. (1987). The dexamethasone suppression test predictive of the therapeutic response to specific antidepressants: Psychiatrie & Psychobiologie Vol 2(1) Feb 1987, 34-40. *Diller, N. (1982). Worldwide clinical experience with Ludiomil: Activitas Nervosa Superior Vol 24(2) 1982, 40-54. *Dominguez, R. A. (1983). Evaluating the effectiveness of the new antidepressants: Hospital & Community Psychiatry Vol 34(5) May 1983, 405-407. *Dratcu, L., Keating, J. W., Sherwood, R., & Lader, M. (1995). A comparison of augmenting central serotonin and noradrenaline function in healthy subjects: Implications for studies on the neurochemistry of anxiety: Journal of Psychopharmacology Vol 9(2) 1995, 127-135. *Dubovsky, S. L., & Freed, C. (1988). Exercise-induced bronchospasm caused by maprotiline: Psychosomatics: Journal of Consultation Liaison Psychiatry Vol 29(1) Win 1988, 104-106. *Eberhard, G., von Knorring, L., Mellerup, E. T., Nilsson, H. L., & et al. (1989). -3HImipramine binding in idiopathic pain syndromes: Basal values and changes after treatment with antidepressants: Pain Vol 38(3) Sep 1989, 261-267. *Eberhard, G., von Knorring, L., Nilsson, H. L., Sundequist, U., & et al. (1988). A double-blind randomized study of clomipramine versus maprotiline in patients with idiopathic pain syndromes: Neuropsychobiology Vol 19(1) Aug 1988, 25-34. *Eberhard, G., von Knorring, L., Nilsson, H. L., Sundequist, U., & et al. (1989). Predictors for the outcome of treatment with antidepressants in patients with idiopathic pain syndromes: Nordisk Psykiatrisk Tidsskrift Vol 43(Suppl 20) 1989, 114-120. *Eisen, J. N., Irwin, J., Quay, J., & Livnat, S. (1989). The effect of antidepressants on immune function in mice: Biological Psychiatry Vol 26(8) Dec 1989, 805-817. *Fabre, L. F. (1985). Treatment of depression in outpatients: A controlled comparison of the onset of action of amoxapine and maprotiline: Journal of Clinical Psychiatry Vol 46(12) Dec 1985, 521-524. *Fahndrich, E. (1983). Effect of sleep deprivation as a predictor of treatment response to antidepressant medication: Acta Psychiatrica Scandinavica Vol 68(5) Nov 1983, 341-344. *Faltus, F. (1985). Electroconvulsive and infusion therapy in depression: Activitas Nervosa Superior Vol 27(4) Dec 1985, 249. *Faltus, F., & et al. (1982). A double-blind comparison of nomifensine, maprotiline and imipramine in the treatment of depression: Activitas Nervosa Superior Vol 24(4) 1982, 213-214. *Filip, V., Hoschl, C., Karen, P., Seifertova, D., & et al. (1993). Predicting therapeutic results with levoprotiline and maprotiline in major depression: The role of the outcome criteria: British Journal of Psychiatry Vol 163(Suppl 21) Sep 1993, 35-38. *Flechter, S., & et al. (1983). Convulsive attacks due to antidepressant drug overdoses: Case reports and discussion: General Hospital Psychiatry Vol 5(3) Sep 1983, 217-221. *Fuchs, A., Hehnke, U., Erhart, C., Schell, C., & et al. (1993). Video rating analysis of effect of maprotiline in patients with dementia and depression: Pharmacopsychiatry Vol 26(2) Mar 1993, 37-41. *Gachoud, J. P., Dick, P., & Kohler, M. (1994). Comparison of the efficacy and tolerability of moclobemide and maprotiline in depressed patients treated by general practitioners: Clinical Neuropharmacology Vol 17(Suppl 1) 1994, S29-S37. *Ghadirian, A. M., & Ananth, J. (1989). Safety of maprotiline in treatment of cardiac patients with left anterior hemiblock: Psychiatric Journal of the University of Ottawa Vol 14(3) Sep 1989, 476-477. *Gillman, M. A., & Sandyk, R. (1985). Maprotiline in nocturnal enuresis: Journal of Clinical Psychiatry Vol 46(12) Dec 1985, 546. *Guimaraes, F. S., Zuardi, A. W., & Graeff, F. G. (1987). Effect of chlorimipramine and maprotiline on experimental anxiety in humans: Journal of Psychopharmacology Vol 1(3) 1987, 184-192. *Gwirtsman, H. E., & et al. (1983). Therapeutic superiority of maprotiline versus doxepin in geriatric depression: Journal of Clinical Psychiatry Vol 44(12) Dec 1983, 449-453. *Hanus, H., Libiger, J., Zapletalek, M., & Valach, M. (1981). Changes in EEG power spectrum after maprotiline and pyrazidol: Activitas Nervosa Superior Vol 23(3) Sep 1981, 202-204. *Harris, J. P., Gelbtuch, M. H., & Phillipson, O. T. (1986). Effects of haloperidol and nomifensine on the visual aftereffects of tilt and movement: Psychopharmacology Vol 89(2) Jan 1986, 177-182. *Hewer, W., Rost, W., & Gattaz, W. F. (1995). Cardiovascular effects of fluvoxamine and maprotiline in depressed patients: European Archives of Psychiatry and Clinical Neuroscience Vol 246(1) 1995, 1-6. *Hoencamp, E., & Haffmanns, P. J. (1991). Brofaromine vs. maprotiline plus lithium in treatment-resistant depressed outpatients: Psychiatry Research Vol 36(3) Mar 1991, 333-335. *Hoencamp, E., Haffmans, P. M. J., Dijken, W. A., Hoogduin, C. A. L., & et al. (1994). Brofaromine versus lithium addition to maportiline: A double-blind study in maprotiline refractory depressed outpatients: Journal of Affective Disorders Vol 30(3) Mar 1994, 219-227. *Hoes, M. J., & Sijben, N. (1981). The clinical significance of disordered renal excretion of xanthurenic acid in depressive patients: Psychopharmacology Vol 75(4) Dec 1981, 346-349. *Holliday, W., Brasfield, K. H., & Powers, B. (1982). Grand mal seizures induced by maprotiline: American Journal of Psychiatry Vol 139(5) May 1982, 673-674. *Holmberg, G. (1988). Sedative effects of maprotiline and amitriptyline: Acta Psychiatrica Scandinavica Vol 77(5) May 1988, 584-586. *Hopes, H., & Wandmacher, J. (1992). A comparison of the effect of lofepramine, maprotiline and placebo on information processing in healthy volunteers: Human Psychopharmacology: Clinical and Experimental Vol 7(3) May-Jun 1992, 183-191. *Hrdlicka, M. (2002). Combination of clozapine and maprotiline in refractory psychotic depression: European Psychiatry Vol 17(8) Dec 2002, 484. *Indaco, A., Orefice, G., & Carrieri, P. (1984). Mianserin versus maprotiline in patients with a depressive syndrome: Acta Neurologica Vol 6(2) Apr 1984, 140-146. *Isbir, T., Unal, M., Yesilsoy, C., & Tukel, S. (1987). Action of maprotilin on the erythrocyte membrane Na-super(+)K-super(+)/Mg-super(++) ATPase and Ca-super(++)/Mg-super(++) ATPase in depressed patients: International Journal of Psychosomatics Vol 34(2) 1987, 15-17. *Jakovljevic, M., Vujic, D., Henigsberg, N., Aleksandrovsky, Y., Faltus, F., & Szelenberger, W. (1998). Central-east European study of fluoxetine (SSRI) and maprotiline (NRI) in major depressive episode: Psychiatria Danubina Vol 10(3) Sep 1998, 287-292. *Kabes, J., Dostal, T., & Roth, Z. (1982). Clinical experience with maprotiline: Activitas Nervosa Superior Vol 24(2) 1982, 93-98. *Kasper, S., Dotsch, M., Kick, H., Vieira, A. H., & et al. (1993). Plasma concentrations of fluvoxamine and maprotiline in major depression: Implications on therapeutic efficacy and side effects: European Neuropsychopharmacology Vol 3(1) Mar 1993, 13-21. *Kasper, S., Voll, G., Vieira, A., & Kick, H. (1990). Response to total sleep deprivation before and during treatment with fluvoxamine or maprotiline in patients with major depression: Results of a double-blind study: Pharmacopsychiatry Vol 23(3) May 1990, 135-142. *Koncevoj, V. A., Andrusenko, M. P., Pjatnickij, A. N., Kolibas, E., & et al. (1989). Comparison of amitriptyline and maprotiline in old depressed patients: Activitas Nervosa Superior Vol 31(2) Jun 1989, 117-118. *Konig, F., Wolfersdorf, M., Loble, M., Wossner, S., & Hauger, B. (1997). Trimipramine and maprotiline plasma levels during combined treatment with moclobemide in therapy-resistant depression: Pharmacopsychiatry Vol 30(4) Jul 1997, 125-127. *Kontsevoy, V. A., Kolibash, E., Pyatnitsky, A. N., Korzhinkova, V., & et al. (1990). A comparative study of the effects of tri- and tetracyclic antidepressants in therapy of late depressions: Trudy Leningradskogo Nauchno-Issledovatel'skogo Psikhonevrologicheskogo Instituta im V M Bekhtereva Vol 125 1990, 40-46. *Kontsevoy, V. A., Kolibash, E., Pyatnitsky, A. N., Korzhinkova, V., & et al. (1991). A comparative age-associated study of the efficacy of tri- and tetracyclic antidepressants: Zhurnal Nevropatologii i Psikhiatrii imeni S S Korsakova Vol 91(9) 1991, 58-65. *Kress, J.-J., & et al. (1981). Study concerning the use of maprotiline 75 mg in moderate or severe depression (experiment in 20 cases): Psychologie Medicale Vol 13(9) Sep 1981, 1473-1481. *Kucukalic, A., & Loga, S. (1991). Biological predictors of response to treatment with antidepressive drugs in major depression: Psychiatria Danubina Vol 3(4) 1991, 451-467. *Kudoh, A., Katagai, H., & Takazawa, T. (2003). Current perception thresholds of patients with long-term administration of maprotiline: Pharmacopsychiatry Vol 36(2) Mar-Apr 2003, 57-60. *Kuha, S., Mehtonen, O.-P., Henttonen, A., & Naarala, M. (1991). The efficacy of fluoxetine versus maprotiline in depressed patients and by dose: Nordisk Psykiatrisk Tidsskrift Vol 45(2) 1991, 109-117. *Lamb, R. J., & McMillan, D. E. (1986). The effects of some putative antidepressant agents on the schedule-controlled behavior of the pigeon: Psychopharmacology Vol 88(3) Mar 1986, 368-373. *Leitersdorf, E., Goshen, R., & Shefer, A. (1982). Atypical ventricular tachycardia in combined tetracyclic, antidepressant, neuroleptic and anticholinergic drugs interaction: International Journal of Psychiatry in Medicine Vol 12(2) 1982-1983, 85-91. *Levin, A. (1982). Nomifensine and maprotiline in endogenous depression: Comparative efficacy and side effects: International Pharmacopsychiatry Vol 17(Suppl 1) 1982, 89-96. *Libiger, J., Hanus, H., Zapletalek, M., & Valach, M. (1984). Spectral EEG analysis after application of antidepressants in healthy volunteers: Activitas Nervosa Superior Vol 26(1) 1984, 47-48. *Libigerova, E. (1989). Infusions of maprotiline in depressive out-patients: Activitas Nervosa Superior Vol 31(4) Dec 1989, 286-287. *Lima, C. A. d. M., Vandel, S., Bonin, B., Bechtel, P., & Carron, R. (1997). Maprotiline versus fluvoxamine: Comparison between their actions on hypothalamic-pituitary-thyroid axis: L'Encephale Vol 23(1) Jan-Feb 1997, 48-55. *Lindsay, P. G., & Olsen, R. B. (1985). Maprotiline in pain-depression: Journal of Clinical Psychiatry Vol 46(6) Jun 1985, 226-228. *Loo, H., Benkelfat, C., Poirier, M.-F., Vanelle, J.-M., & et al. (1986). Plasma 3,4-dihydroxyphenylethyleneglycol and therapeutic response to maprotiline and indalpine in major depression: Neuropsychobiology Vol 15(2) Jul 1986, 62-67. *Luckhaus, C., & Jacob, C. (2001). Venlafaxine withdrawal syndrome not prevented by maprotiline, but resolved by sertraline: International Journal of Neuropsychopharmacology Vol 4(1) Mar 2001, 43-44. *Malinen, L., & Wuolijoki, E. (1982). Active and passive control of a recently registered drug: Unwanted effects of Ludiomil (maprotiline) in Finland: Nordisk Psykiatrisk Tidsskrift Vol 36(6) 1982, 305-308. *Mani, C., Williams, A. J., & Castleden, C. M. (1983). Increased sensitivity to maprotiline in an elderly patient: Clinical Gerontologist Vol 1(4) Sum 1983, 71-73. *Martenyi, F., Dossenbach, M., Mraz, K., & Metcalfe, S. (2001). Gender differences in the efficacy of fluoxetime and maprotiline in depressed patients: A double-blind trial of antidepressants with serotonergic or norepinephrinergic reuptake inhibition profile: European Neuropsychopharmacology Vol 11(3) Jun 2001, 227-232. *Masuda, Y., Takemura, T., & Sugiyama, T. (1998). Hypertriglyceridemia associated with the treatment of amitriptyline and maprotiline: Human Psychopharmacology: Clinical and Experimental Vol 13(7) Oct 1998, 527-528. *Mattes, J. A. (1986). Side effects of the new antidepressants: American Journal of Psychiatry Vol 143(2) Feb 1986, 261. *Mikkelsen, P. L., & et al. (1982). Hyposalivation after single doses of antidepressants: International Pharmacopsychiatry Vol 17(Suppl 1) 1982, 35-42. *Misurec, J., Nahunek, K., Svestka, J., & Ceskova, E. (1982). EEG changes after single-dose maprotiline and their correlation with the therapeutic effect: Activitas Nervosa Superior Vol 24(4) 1982, 288-289. *Mogilnicka, E., Boissard, C. G., Waldmeier, P. C., & Delini-Stula, A. (1983). The effects of single and repeated doses of maprotiline, oxaprotiline and its enantiomers on foot-shock induced fighting in rats: Pharmacology, Biochemistry and Behavior Vol 19(4) Oct 1983, 719-723. *Moldawsky, R. J. (1984). Hepatotoxicity associated with maprotiline therapy: Case report: Journal of Clinical Psychiatry Vol 45(4) Apr 1984, 178-179. *Moller, H. J., Riehl, T., Dietzfelbinger, T., & Wernicke, T. (1991). A controlled study of the efficacy and safety of mianserin and maprotiline in outpatients with major depression: International Clinical Psychopharmacology Vol 6(3) Win 1991, 179-192. *Moller, S. E., & et al. (1986). Plasma tryptophan and tyrosine ratios to competing amino acids in relation to antidepressant response to citalopram and maprotiline: A preliminary study: Psychopharmacology Vol 88(1) Jan 1986, 96-100. *Montejo-Iglesias, M. L., & Ramos-Brieva, J. A. (1988). Therapeutic effect of maprotiline and chlorimipramine: Controlled study: Neuropsychobiology Vol 19(1) Aug 1988, 20-24. *Morishita, S., & Arita, S. (2005). Treatment of Bipolar II Depression with Milnacipran, Fluvoxamine, Paroxetine, or Maprotiline: International Medical Journal Vol 12(4) Dec 2005, 283-285. *Mornstad, H., von Knorring, L., Forsgren, L., & Holmgren, S. (1986). Acute effects of some different antidepressant drugs on saliva composition: Neuropsychobiology Vol 15(2) Jul 1986, 73-79. *Muscat, R., Papp, M., & Willner, P. (1992). Reversal of stress-induced anhedonia by the atypical antidepressants, fluoxetine and maprotiline: Psychopharmacology Vol 109(4) Dec 1992, 433-438. *Nahunek, K., Svestka, J., Ceskova, E., & Rysanek, R. (1984). Maprotiline in the treatment and prophylaxis of periodic endogenous depression: Activitas Nervosa Superior Vol 26(1) 1984, 31-32. *Nahunek, K., Svestka, J., Rysanek, R., & Ceskova, E. (1981). Further clinical experience with maprotiline in endogenous depressions: Activitas Nervosa Superior Vol 23(3) Sep 1981, 214-215. *Nakra, B. R., & Grossberg, G. T. (1986). Carbohydrate craving and weight gain with maprotiline: Psychosomatics: Journal of Consultation Liaison Psychiatry Vol 27(5) May 1986, 376-381. *Nassberger, L., & Jensen, E. (1983). Acute maprotiline intoxication: Report on six cases: Nordisk Psykiatrisk Tidsskrift Vol 37(4) 1983, 347-349. *Nemeroff, C. B., & Evans, D. L. (1983). Concurrent use of antidepressants and propranolol: Case report and theoretical considerations: Biological Psychiatry Vol 18(2) Feb 1983, 237-241. *Norman, T. R., & et al. (1983). Maprotiline in affective illness: Plasma concentration and clinical response: Journal of Affective Disorders Vol 5(2) May 1983, 147-154. *Normann, C., Lieb, K., & Walden, J. (2002). Increased plasma concentration of maprotiline by coadministration of risperidone: Journal of Clinical Psychopharmacology Vol 22(1) Feb 2002, 92-94. *Nystrom, C., & Hallstrom, T. (1985). Double-blind comparison between a serotonin and a noradrenaline reuptake blocker in the treatment of depressed outpatients: Clinical aspects: Acta Psychiatrica Scandinavica Vol 72(1) Jul 1985, 6-15. *Nystrom, C., & Hallstrom, T. (1987). Comparison between a serotonin and a noradrenaline reuptake blocker in the treatment of depressed outpatients: A cross-over study: Acta Psychiatrica Scandinavica Vol 75(4) Apr 1987, 377-382. *Nystrom, C., Ross, S. B., Hallstrom, T., & Kelder, D. (1986). Comparison between a serotonin and a noradrenaline reuptake blocker in the treatment of depressed outpatients: Biochemical aspects: Acta Psychiatrica Scandinavica Vol 73(2) Feb 1986, 133-138. *Ohkoshi, N., Satoh, D., Nishi, M., & Shoji, S. i. (2003). Neuroleptic malignant-like syndrome due to donepezil and maprotiline: Neurology Vol 60(6) Mar 2003, 1050-1051. *Pacheco Palha, A., Ferreira, L., Abreu-Lima, C., Ramalhao, C., & et al. (1986). Double-blind study comparing mianserin and maprotiline in treating hospitalized depressive patients: Psychologie Medicale Vol 18(2) Feb 1986, 317-325. *Parra, A., Martos, A., Monleon, S., Arenas, M. C., & Vinader-Caerols, C. (2000). Effects of acute and chronic maprotiline administration on inhibitory avoidance in male mice: Behavioural Brain Research Vol 109(1) Apr 2000, 1-7. *Peabody, C. A., Whiteford, H. A., & Hollister, L. E. (1986). Antidepressants and the elderly: Journal of the American Geriatrics Society Vol 34(12) Dec 1986, 869-874. *Pecknold, J. C., & et al. (1985). Trimipramine and maprotiline: Antidepressant, anxiolytic, and cardiotoxic comparison: Journal of Clinical Psychiatry Vol 46(5) May 1985, 166-171. *Pinar, M., Gulsun, M., Tasci, I., Erdil, A., Bolu, E., Acikel, C., et al. (2008). Maprotiline induced weight gain in depressive disorder: Changes in circulating ghrelin and adiponectin levels and insulin sensitivity: Progress in Neuro-Psychopharmacology & Biological Psychiatry Vol 32(1) Jan 2008, 135-139. *Poelinger, W., & Haber, H. (1989). Fluoxetine 40 mg vs maprotiline 75 mg in the treatment of out-patients with depressive disorders: International Clinical Psychopharmacology Vol 4(Suppl 1) Jan 1989, 47-50. *Poirier, M. F., Galzin, A. M., Loo, H., Pimoule, C., & et al. (1987). Changes in: Biological Psychiatry Vol 22(3) Mar 1987, 287-302. *Price, W. A., & Babai, M. R. (1988). Epileptogenic properties of maprotiline: Psychiatric Forum Vol 14(1) Win 1988, 42-44. *Prien, R. F., Blaine, J. D., & Levine, J. (1985). Antidepressant drug therapy: The role of the new antidepressants: Hospital & Community Psychiatry Vol 36(5) May 1985, 513-516. *Remick, R. A., & et al. (1984). A comparison of the safety and efficacy of zimeldine and maprotiline in depressed outpatients: Current Therapeutic Research Vol 36(1) Jul 1984, 77-85. *Robinson, D. S., & et al. (1984). A comparison of trazodone, amoxapine and maprotiline in the treatment of endogenous depression: Results of a multicenter study: Current Therapeutic Research Vol 35(4) Apr 1984, 549-560. *Rodgers, R. J., Cutler, M. G., & Jackson, J. E. (1997). Behavioural effects in mice of subchronic chlordiazepoxide, maprotiline, and fluvoxamine: II. The elevated plus-maze: Pharmacology, Biochemistry and Behavior Vol 57(1-2) May-Jun 1997, 127-136. *Rouillon, F., Phillips, R., Serrurier, D., Ansart, E., & et al. (1989). Prophylactic efficacy of maprotiline on relapses of unipolar depression: L'Encephale Vol 15(6) Nov-Dec 1989, 527-534. *Rouillon, F., Serrurier, D., Miller, H. D., & Gerard, M.-J. (1991). Prophylactic efficacy of maprotiline on unipolar depression relapse: Journal of Clinical Psychiatry Vol 52(10) Oct 1991, 423-431. *Rouillon, F., Sioufi, A., Serrurier, D., Mizan, J. P., & et al. (1988). Blood levels of maprotiline in depressed inpatients: L'Encephale Vol 14(4) Jul-Aug 1988, 299-305. *Rysanek, R., & et al. (1984). Characteristics of cardial function in the treatment of depressions with dibenzepine and maprotiline: Activitas Nervosa Superior Vol 26(4) 1984, 274-275. *Saiz-Ruiz, J., & Moral, L. (1988). Delirium induced by association of propranolol and maprotiline: Journal of Clinical Psychopharmacology Vol 8(1) Feb 1988, 77-78. *Sandyk, R. (1986). Speech blockage induced by maprotiline: American Journal of Psychiatry Vol 143(3) Mar 1986, 391-392. *Sato, T., Hirano, S., Narita, T., Kusunoki, K., Kato, J., Goto, M., et al. (1999). Temperament and character inventory dimensions as a predictor of response to antidepressant treatment in major depression: Journal of Affective Disorders Vol 56(2-3) Dec 1999, 153-161. *Schatzberg, A. F., & et al. (1981). Toward a biochemical classification of depressive disorders: III. Pretreatment urinary MHPG levels as predictors of response to treatment with maprotiline: Psychopharmacology Vol 75(1) Oct 1981, 34-38. *Schifano, F., Garbin, A., Renesto, V., de Dominicis, M. G., & et al. (1990). A double-blind comparison of mianserin and maprotiline in depressed medically ill elderly people: Acta Psychiatrica Scandinavica Vol 81(3) Mar 1990, 289-294. *Schlienger, J. L., Kapfer, M. T., Singer, L., & Stephan, F. (1980). Different effects of tricyclic (clomipramine and amitriptyline) and tetracyclic (maprotiline) antidepressors on the release of thyroid stimulating hormone, prolactin and growth hormone to thyrostimulating releasing hormone in patients with psychoaffective disorders: Acta Psychiatrica Belgica Vol 80(5) Sep-Oct 1980, 584-599. *Schmauss, M., Laakmann, G., & Dieterle, D. (1987). Oxaprotiline versus maprotiline in inpatients with endogenous depression: A double-blind, controlled study: Current Therapeutic Research Vol 41(3) Mar 1987, 342-350. *Schnyder, U., & Koller-Leiser, A. (1996). A double-blind, multicentre study of paraoxetine and maprotiline in major depression: The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie Vol 41(4) May 1996, 239-244. *Schoffelmeer, A. N., Hoorneman, E. M., Sminia, P., & Mulder, A. H. (1984). Presynaptic alpha-sub-2- and postsynaptic beta-adrenoceptor sensitivity in slices of rat neocortex after chronic treatment with various antidepressant drugs: Neuropharmacology Vol 23(2A) Feb 1984, 115-119. *Schwartz, L., & Swaminathan, S. (1982). Maprotiline hydrochloride and convulsions: A case report: American Journal of Psychiatry Vol 139(2) Feb 1982, 244-245. *Silver, H., & Shmugliakov, N. (1998). Augmentation with fluvoxamine but not maprotiline improves negative symptoms in treated schizophrenia: Evidence for a specific serotonergic effect from a double-blind study: Journal of Clinical Psychopharmacology Vol 18(3) Jun 1998, 208-211. *Simon, J. S., Evans, D. L., & Nemeroff, C. B. (1987). The dexamethasone suppression test and antidepressant response in major depression: Journal of Psychiatric Research Vol 21(3) 1987, 313-317. *Soeda, S., Terao, T., Tani, Y., & Shiratsuchi, T. (1999). A case of senile depression with stupor and excitement responding to lithium addition: Seishin Igaku (Clinical Psychiatry) Vol 41(4) Apr 1999, 440-441. *Steardo, L., Barone, P., Monteleone, P., Iovino, M., & et al. (1987). Is the dexamethasone suppression test predictive of response to specific antidepressant treatment in major depression? : Acta Psychiatrica Scandinavica Vol 76(2) Aug 1987, 129-133. *Steinmeyer, E. M., Vorbach, E. U., & Arnoldt, K. H. (1993). Efficacy and safety of moclobemide compared with maprotiline in treatment of major depressive disorder: A double-blind multicenter study with parallel groups: Pharmacopsychiatry Vol 26(6) Nov 1993, 246-253. *Stier, C. S., Neumann, M., & Elizur, A. (1982). Comparative double-blind study between maprotiline and amitriptyline in one fixed nightly dose in major depressive disorder: Current Therapeutic Research Vol 32(3) Sep 1982, 447-456. *Strzyzewski, W., & et al. (1985). Psychopathological and neurophysiological markers of endogenous depressions and therapeutic effect of thymoleptic drugs: II. A comparison of the effects of certain thymoleptic agents on psychopathological manifestations of endogenous depression syndromes: Psychiatria Polska Vol 19(5) Sep-Oct 1985, 363-369. *Sundequist, U., Eberhard, G., von Knorring, L., Nilsson, H. L., & et al. (1989). Clomipramine and maprotiline in the treatment of chronic idiopathic pain syndromes; a comparison and biological markers: Nordisk Psykiatrisk Tidsskrift Vol 43(Suppl 20) 1989, 95-99. *Szegedi, A., Wetzel, H., Angersbach, D., Dunbar, G. C., & et al. (1997). A double-blind study comparing paroxetine and maprotiline in depressed outpatients: Pharmacopsychiatry Vol 30(3) May 1997, 97-105. *Tan, C.-H., He, X., Yang, J., & Ong, W.-Y. (2006). Changes in AMPA subunit expression in the mouse brain after chronic treatment with the antidepressant maprotiline: A link between noradrenergic and glutamatergic function? : Experimental Brain Research Vol 170(4) Apr 2006, 448-456. *Timmerman, L., de Beurs, P., Tan, B. K., Leijnse-Ybema, H., Sanchez, C., Hopfner Petersen, H. E., et al. (1987). A double-blind comparative clinical trial of citalopram vs maprotiline in hospitalized depressed patients: International Clinical Psychopharmacology Vol 2(3) Jul 1987, 239-253. *Tollefson, G. D., Montague-Clouse, J., Lesar, T., & Garvey, M. J. (1989). Pharmacokinetic properties of maprotiline in geriatric depression: Journal of Clinical Psychopharmacology Vol 9(4) Aug 1989, 313-315. *Truffinet, P., Rouillon, F., Serrurier, D., Phillips, R., & et al. (1990). Relapses of unipolar depression in the elderly and the efficacy of maprotiline: Psychologie Medicale Vol 22(8) Jun 1990, 769-777. *Twarowska-Hauser, J., & et al. (1985). Psychopathological and neurophysiological markers of endogenous depressions and the therapeutic effect of thymoleptic drugs: I. Analysis of the clinical effects of antidepressants of different pharmacological profiles: Psychiatria Polska Vol 19(5) Sep-Oct 1985, 357-362. *Twarowska-Hauser, J., & Strzyzewski, W. (1985). Psychopathological and neurophysiological markers of endogenous depressions and the therapeutic effect of thymoleptic drugs: III. Analysis of factors influencing the effectiveness of treatment with thymoleptic agents: Psychiatria Polska Vol 19(5) Sep-Oct 1985, 370-375. *Udelman, D. L., & Udelman, H. D. (1985). A preliminary report on anti-depressant therapy and its effects on hope and immunity: Social Science & Medicine Vol 20(10) 1985, 1069-1072. *Van Bork, J. J. (1986). The influence of unconscious defense mechanisms induced by maprotiline and mianserin: A psychodynamic explanation of the therapeutic effect of some antidepressant drugs: Tijdschrift voor Psychiatrie Vol 28(8) 1986, 573-581. *Van der Velde, C. D. (1981). Maprotiline versus imipramine and placebo in neurotic depression: Journal of Clinical Psychiatry Vol 42(4) Apr 1981, 138-141. *Vartanyan, F. E. (1984). Effects of antidepressants in different populations: Farmakologiya i Toksikologiya Vol 47(1) 1984, 13-17. *Vaz-Serra, A., Figueira, M. L., Firmino, H., Albuquerque, A. J., & et al. (1994). Multicenter double-blind study of moclobemide and maprotiline: Clinical Neuropharmacology Vol 17(Suppl 1) 1994, S38-S49. *Vinader-Caerols, C., Ferrer-Ano, A., Arenas, M. C., Monleon, S., & Parra, A. (2002). Maprotiline removes differences between male and female mice in the Morris water maze: Psicothema Vol 14(4) Nov 2002, 823-827. *Vinader-Caerols, C., Martos, A. J., Monleon, S., Arenas, M. C., & Parra, A. (2006). Acute effects of maprotiline on learning, anxiety, activity and analgesia in male and female mice: Acta Neurobiologiae Experimentalis Vol 66(1) 2006, 23-31. *von Knorring, L., & Mornstad, H. (1986). Saliva secretion rate and saliva composition as a model to determine the effect of antidepressant drugs on cholinergic and noradrenergic transmission: Neuropsychobiology Vol 15(3-4) Sep 1986, 146-154. *Vrethem, M., Boivie, J., Arnqvist, H., Holmgren, H., Lindstrom, T., & Thorell, L.-H. (1997). A comparison of amitriptyline and maprotiline in the treatment of painful polyneuropathy in diabetics and nondiabetics: Clinical Journal of Pain Vol 13(4) Dec 1997, 313-323. *Wallimann, G. (1981). Study of the use of maprotiline 75 in current medical practice: Psychologie Medicale Vol 13(11) Oct 1981, 1815-1829. *Watson, C. P., Chipman, M., Reed, K., Evans, R. J., & et al. (1992). Amitriptyline versus maprotiline in postherpetic neuralgia: A randomized, double-blind, crossover trial: Pain Vol 48(1) Jan 1992, 29-36. *Weinstein, R. P., & Gosselin, J.-Y. (1988). Case report of hepatotoxicity associated with maprotiline: The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie Vol 33(3) Apr 1988, 233-234. *Zapletalek, M., Zbytovsky, J., & Kudrnova, K. (1982). Clinical experience with maprotilin and maprotilin/clomipramine infusions in resistant depression: Activitas Nervosa Superior Vol 24(2) 1982, 73-76. *Zwicker, A. P., del Porto, J. A., & Carlini, E. A. (1984). Anticholinergic effects of mianserin, maprotiline, amitriptyline, and imipramine in healthy volunteers: Jornal Brasileiro de Psiquiatria Vol 33(5) Oct 1984, 339-347. External links * Maprotiline drug information * rxlist.com * Schweizer Arzneikompendium (German) Category:Norepinephrine reuptake inhibitors Category:Tetracyclic antidepressant drug